At the University of Louisville (UofL) we have implemented a multidisciplinary Bone and Joint (B&J) Infection Service. The objective of this study was to review our experience with the use of telavancin in patients with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis.
This study was a retrospective, observational study of patients managed by the B&J service at UofL Hospital. Patients with MRSA osteomyelitis treated with telavancin at a dose of 10mg/kg IV q24h adjusted for renal function were reviewed. Patients who deteriorated during antibiotic therapy or relapsed after completing therapy requiring surgical intervention were considered failures. Safety was evaluated during clinical visits and via weekly laboratory assessment of CBC and complete metabolic panels.
A total of 14 patients were enrolled in the study; the mean age was 50 years (range 35-67 years), and 11 were male. The most common underlying conditions were diabetes mellitus, hypertension, smoking history, and prior hospitalization. Sites of infection included vertebrae (1), pelvis (2), lower extremity (4), diabetic foot (3), upper extremity (2), knee prosthetic joint infection (2). Four patients had concurrent MRSA bacteremia with no episodes of bacteremia after telavancin was initiated. The median duration of therapy was 58 days. Eleven patients received prior anti-MRSA antibiotics for a median of 4 days. Clinical outcome evaluation was available in 9 patients. At end-of-treatment, 8/9 (89%) patients were considered cured. At 12-months follow-up, 5 patients maintained clinical cure, and 4 patients were considered clinical failure necessitating hardware removal. Adverse events were documented in 7/14 (50%) of patients with two of them requiring discontinuation of telavancin due to infusion-related chills/rigors. The most common antibiotic-associated adverse events were nephrotoxicity (1), infusion-related chills/rigors (2), thrombocytopenia (1), nausea/vomiting (1), elevated transaminases (1), and rhabdomyolysis (1).
This pilot study suggests that telavancin may have a role in in the treatment of MRSA osteomyelitis. Larger prospective assessment is necessary to define telavancin's efficacy compared to vancomycin for treatment of MRSA osteomyelitis.
R. Kelley, None
T. L. Wiemken, None
P. Peyrani, None
J. A. Ramirez, Theravance, Inc.: Investigator , Research grant